Asbestos project notification and inspection report form

NYC 9/11 Public Portal Document

A. -- „ ~ 4\ NYC DEPARTMENT OF ENVIRONMENTAL PROTECTION

D^ p \9 Asbestos Control Program 59-17 Junction Boulevard, 8 „ Floor. Corona. NY 11368-5107 Building Dept. or TRU No ONLY FOR OFFICUL USE ONLY TPEWRIT.TEN / I ASBESTOS PROJECT NOTIFICATION FORMS WILL BE (ASBESTOS INSPECTION REPORT) ACCEPTED i •••.•.c.r•i••fl 1. IS" IAA tt #1 AAl

When submitting this form at the NYC Depe signatures are required. Submittal at the P form must be submitted to the NYC DEP not

I. FACILITY

2. Address 48 Beaver Street AKA

5. Type of Facility II. BUILDING OWNER

7. Name 56 Beaver Street

Time Equities ct ' cç 2J')2 9. Tel. # 212-206-5694 10. Address Fax# __ M ra

Ill. GENERAL CONTRACTOR

11. Name_ _ Tel. # IV. ASBESTOS ABATEMENT CONTRACTOR

12.Name Trio Asbestos Removal Corp. 13. Contact Person Chris Horan

14. Federal EmployerlD.#______P-~______ 15. Tel.#718-961-4100 Fax# 718-961-4103 16.Address_ 14-20 129th Street CityCollege Point State NY Zip 11 356 V. THIRD PARTY AIR MONITOR

17:Name Warren & Panzer Engineers, P.C. 18. Contact Person Michael Nolan

19. Federal Employer ID. # 20. Tel. # 21 2-922-0077 Fax# 21 2-922-0630 21.Address228 East 45th Street City New York State NY Zip 10017 22. Sample Analysis Laboratory Warren & Panzer Engineers 23. NYS DOH ELAP # 1 1 251' VI. PROJECT INFORMATION 24. Starting date for this portion of work Projected completion date

Asbestos work schedule ❑ Monday ❑ Tuesday ❑ Wednesday ❑ Thursday ❑ Friday ❑ Saturday ❑ Sunday

Shift from: ______Dam ❑pm to Dam ❑pm

If other, specify _

Access to inspect the premises must be provided during the work schedule indicated in this item.

25. Total amount of asbestos-containing material to be abated during this work

.....3..,,_250 _ Square Feet, andlor _ Linear Feet 7 )1

NYC-WTC 000111220